A guide to children and young people's mental health – the role of education
The House of Commons Education and Health Committees report, Children and young people’s mental health —the role of education, released on 2 May 2017, is a mixed bag.
The authors state: "The decision to hold an early election has meant that we have been unable to go into the depth that we would have liked in this report." It shows.
There are many platitudes: "Schools and colleges have a front line role in promoting and protecting children and young people’s mental health and well-being" and "… teachers should be given adequate training and opportunities for continuing professional development." However, once you strip away the padding, there are some welcome recommendations in this 38 page report.
The Office for National Statistics (ONS) and NatCen Social Research were commissioned by the Health and Social Care Information Centre (HSCIC) to carry out the Survey of the Mental Health of Children and Young People (MHCYP) 2016.
There has been no attempt to gather statistics on what they call, "children and young people’s mental health prevalence" since 2004 and this is definitely a toe dipping exercise, calling on experts from health and education as well as some schools.
The statistics they have pulled together provide a striking introduction to the report:
- 50% of mental illness in adult life (excluding dementia) starts before age fifteen and 75% has started by age eighteen.
- According to the last ONS prevalence survey, in 2004, around 10% of children between five and sixteen had a clinically diagnosed mental disorder.
Schools will be in the forefront of this initiative because: "Teachers are often amongst the first to notice if a pupil has mental health issues as well as being the people to whom parents are most likely to turn when they suspect something may be wrong." While this is probably true, the proposal will not address the needs of those children who are regularly absent from school.
Figures for pupil absence in schools in England: 2015 to 2016 were published by the Department for Education in March 2017: "The overall absence rate for persistent absentees across all schools was 17.6 per cent, nearly four times higher than the rate for all pupils. This is a slight increase from 2014/15, when the overall absence rate for persistent absentees was 17.3 per cent."
Many of these will be absent because of mental health issues.
The plan is that schools will be responsible for promoting emotional resilience and well-being for all children and for referring children with identifiable symptoms of diagnosed mental illness to Child and Adolescent Mental Health Services (CAMHS) for specialist targeted intervention.
Personal, social, health and economic education (PSHE) will be compulsory and will play a key role but the report stresses it is a whole-school responsibility: "…senior leadership must embed well-being throughout their provision and culture. Doing so will have implications for staffing and training and the balance of provision and delivery of subjects across the curriculum to allow more time to focus on well-being and building resilience. We believe that this would be in the best interests of children and young people." (Paragraph 13)
Schools will also be expected to advise young people on social media, in PSHE lessons. While some of those who gave evidence advocated banning mobile phones in schools, there is to be an emphasis on teaching children to assess and manage the risks of social media and "providing them with the skills and ability to make wiser and more informed choices about their use of social media." (Paragraph 47)
Personal development and well-being criteria have been included in the Ofsted inspection framework since 2015 but there have been concerns that would turn into a box ticking exercise. This was backed up by an analysis of Ofsted reports by the Institute for Public Policy Research which found that only a third made explicit reference to pupils’ mental health and well-being. (Paragraph 15).
However, Emily Frith, of the Education Policy Institute, reflected a commonly held view that, "…the benefit of having Ofsted look at wellbeing is that it is a signal to schools that it is part of their job, and it is not just about accountability measures and the academic side." (Paragraph 14)
The report recommends: "The recently appointed Chief Inspector should, as a matter of priority, consider ways in which the inspection regime gives sufficient prominence to well-being." (Paragraph 16)
There is likely to be a mandatory module on mental health in initial and continuing professional development training for existing teachers. The objective is to help teachers recognise the early signs of mental illness and have the confidence to be able to signpost or refer pupils to the right support. (Paragraph 25)
Arts, exercise and well-being
There is a clear acknowledgment that the current education system is partly to blame for the high number of children with mental health issues.
Evidence presented to the inquiry suggested that schools were so pressurised to achieve good exam results that they were cutting back on the arts, music and physical activity that can help develop life-long skills to improve well-being. (Paragraph 18)
There were clear attempts to sell the benefits of well-being to sceptical schools: "Achieving a balance between promoting academic attainment and well-being should not be regarded as a zero-sum activity. Greater well-being can equip pupils to achieve academically. If the pressure to promote academic excellence is detrimentally affecting pupils, it becomes self-defeating." (Recommendations Paragraph 6)
Despite the fine words, it is likely that many schools will come down on the side of good exam results.
As expected, social media comes in for criticism:
- The 2014 Health Behaviours of School-Aged Children (HBSC) survey of 11, 13, and 15 year olds found that 18% of young people reported having experienced cyberbullying in the past two months
- The second wave of the Longitudinal Study of Young People in England 2, in 2014, found that 11% of 15 year olds had experienced cyberbullying
- The NSPCC reported that in 2015–16, there were more than 11,000 Childline counselling sessions relating to online sexual abuse, cyber-bullying and internet safety, a 9% increase on the previous year (Paragraph 41)
The benefits of social media for those young people who need support yet cannot or will not use face to face interventions was skirted over, although Emily Frith, Director of Mental Health, Education Policy Institute, pointed out: "Young people access Childline online now rather than phoning the number. There are lots of ways young people can support each other through social media, particularly if they have a rare condition. Being able to connect with other young people with the same set of experiences online has been shown to be really supportive." (Paragraph 42)
Sleep deprivation was recognised as a key contributor to depression for young people. It was mentioned eight times but each time was linked to the use of digital technology. However, it seems probable that, for some young people, domestic violence, hunger and worry are likely to be the cause of sleeplessness.
There are plans to call social media providers to account to protect children and young people from cyber-bullying, sexual predators and violent or distressing content. "These organisations and providers must not be allowed to duck their own responsibility for preventing harm to children and young people." (Paragraph 52)
Parents and schools will need information and support to become more aware of the effect of social media on young people's moods and mental states. Apparently, the Government plans to bring forward a range of resources to support parents as well as teachers. (Paragraph 48). No further news as yet.
Building on pilots and good practice
- Regent High School was praised as a good example of inter-agency co-ordination. The Tavistock and Portman NHS Foundation Trust were commissioned to run CAMHS by the Camden Clinical Commissioning Group and Camden Local Authority and provided a more co-ordinated approach to mental health care with senior staff members from the Trust located in the local schools
- In 2015–16, DfE worked with NHS England on a £3million pilot to provide joint training to schools and CAMHS staff. The evaluation of the pilot found that there were clear benefits when schools and NHS CAMHS engaged in joint planning and training activities, when there were signposts to specialist mental health support, and named points of contact in schools and NHS CAMHS.
The impact has been severe. Schools are cutting back on in-house pastoral staff and do not have sufficient funding to outsource therapeutic services.
"In 2015, the Government announced £1.25bn in extra funding for young people’s mental health. However, as schools see their funding cut, an increasing number are cutting back on mental health services such as in-school counsellors." (Paragraph 34)
"In January 2017, the National Association of Headteachers (NAHT) and Place2Be conducted a survey of children’s mental health which found that around 64% of primary schools do not have access to a school based counsellor and 78% of those surveyed reported financial constraints as a barrier to providing mental health services for students." (Paragraph 35)
Edward Timpson MP, Minister of State for Vulnerable Children and Families, " was unable to provide a “full picture” as a children and young people’s mental health prevalence survey has not been completed since 2004"
This is a more superficial report than many of us would have wanted, but there are some grounds for hope. The key points are:
- Schools need to pay heed to well-being
- Young people are put under pressure when there is a continual emphasis on academic achievement
- Agencies need to work together with more mental health professionals in schools
- Senior management and Ofsted have a role to play or else it will be the PSHE teachers who carry the can
- Finally, and most importantly, there must be adequate funding in all parts of the country:
- "We know that over half of all mental ill health starts before the age of fifteen and it is therefore a false economy to cut services for children and young people."
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